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The chronically mentally ill in primary care1

Published online by Cambridge University Press:  09 July 2009

Darrel A. Regier*
Affiliation:
NIMH Division of Biometry and Epidemiology, Rockville, Maryland, USA
Jack D. Burke Jr
Affiliation:
NIMH Division of Biometry and Epidemiology, Rockville, Maryland, USA
Ronald W. Manderscheid
Affiliation:
NIMH Division of Biometry and Epidemiology, Rockville, Maryland, USA
Barbara J. Burns
Affiliation:
NIMH Division of Biometry and Epidemiology, Rockville, Maryland, USA
*
2Address for correspondence: Dr D. A. Regier, Room 18C-26, 5600 Fishers Lane, Rockville, MD 20857, USA.

Synopsis

The role of primary care physicians in addressing the needs of chronically mentally ill patients is examined from three perspectives: (1) assessing community prevalence; (2) treating chronic medical problems in the context of other human service needs; and (3) treating specific types of chronic mental disorders. About 30% of primary care patients were found to have at least one Research Diagnostic Criteria mental disorder, five-sixths of which had a duration greater than 1 year. However, about 9% of patients had some impairment and 2% had severe impairment associated with a mental disorder. Although affective disorders have the highest overall rates, personality, psychotic, and anxiety disorders contribute the greatest proportion of severe disability.

Type
Research Article
Copyright
Copyright © Cambridge University Press 1985

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Footnotes

1

Based on a paper presented at the 1982 Symposium of the Section of Epidemiology and Community Psychiatry of the World Psychiatric Association, 1982.

References

Aiken, L. H., Lewis, C. E., Craig, J., Mendenhall, R. C., Blendon, R. J. & Rogers, D. E. (1979). The contribution of specialists to the delivery of primary care: a new perspective. New England Journal of Medicine 300, 13631370.CrossRefGoogle Scholar
American Psychiatric Association (1980). Diagnostic and Statistical Manual of Mental Disorders (third edn) (DSM-III). APA: Washington, D.C.Google Scholar
Bielski, R. J. & Friedel, R. O. (1979). Depressive subtypes defined by response to pharmacotherapy. Psychiatric Clinics of North America 2, 483497.CrossRefGoogle Scholar
Boyd, J. H. & Weissman, M. M. (1981). Epidemiology of affective disorders. Archives of General Psychiatry 38, 10391046.CrossRefGoogle ScholarPubMed
Burns, B. J., Burke, J. D. & Kessler, L. G. (1981). Federal efforts to promote general health–mental health coordination. In Linking Health and Mental Health: Coordinating Care in the Community (ed. Broskowski, A., Marks, E. and Budman, S.), pp. 2743. Sage Publications: Beverley Hills.Google Scholar
Endicott, J. & Spitzer, R. L. (1978). A diagnostic interview: the Schedule for Affective Disorders and Schizophrenia. Archives of General Psychiatry 35, 837844.CrossRefGoogle ScholarPubMed
Endicott, J. E., Spitzer, R. L., Fleiss, J. L. & Cohen, J. (1976). The global assessment scale. Archives of General Psychiatry 33, 766771.CrossRefGoogle ScholarPubMed
Goldberg, D. P. (1978). Manual of the General Health Questionnaire. NFER Publishing Company: Windsor.Google Scholar
Goldberg, D. P. (1982). The concept of a psychiatric ‘case’ in general practice. Social Psychiatry 17, 6165.CrossRefGoogle Scholar
Goldberg, D. P. & Huxley, P. (1980). Mental Illness in the Community: The Pathway to Psychiatric Care. Tavistock Publications: London.Google Scholar
Goldman, H. H., Burns, B. J. & Burke, J. D. (1980). Integrating primarily mental health care and mental health services: a preliminary report. Public Health Reports 95, 6165.Google Scholar
Goldman, H. H., Gatozzi, A. A. & Taube, C. A. (1981). Defining and counting the chronically mentally ill. Hospital and Community Psychiatry 32, 2127.Google ScholarPubMed
Gruenberg, E. M. & Pepper, B. (1982). Definitions of mental illness, patient, disability and chronic. Presented at symposium of the Section of Epidemiology and Community Psychiatry, 05 10–13, Baltimore, Maryland.Google Scholar
Hankin, J. & Oktay, J. (1979). Mental Disorder in Primary Medical Care: An Analytic Review of the Literature. NIMH Series D, No. 5, DHEW Publication No. (ADM) 78–661. US Government Printing Office: Washington, D.C.Google Scholar
Hankin, J., Steinwachs, D. M., Regier, D. A., Burns, B. J., Goldberg, I. D. & Hoeper, E. W. (1982). Use of general medical care services by persons with mental disorders. Archives of General Psychiatry 39, 225231.CrossRefGoogle ScholarPubMed
Harding, T. W., DeArango, M. V., Baltazar, J., Climent, C. E., Ibrahim, H. H., Ladrido-Ignacio, L., Murthy, R. S. & Wig, N. N. (1980). Mental disorders in primary health care: a study of their frequency and diagnosis in four developing countries. Psychological Medicine 10, 231241.CrossRefGoogle ScholarPubMed
Hoeper, E. W., Nycz, G. R., Clearly, P. D., Regier, D. A. & Goldberg, I. D. (1979). Estimated prevalence of RDC mental disorder in primary medical care. International Journal of Mental Health 8, 615.CrossRefGoogle Scholar
Hoeper, E. W., Nycz, G. R., Kessler, L. G., Burke, J. D. & Pierce, E. W. (1984). The usefulness of screening for mental illness. Lancet i, 3335.CrossRefGoogle Scholar
Johnstone, A. & Goldberg, D. P. (1976). Psychiatric screening in general practice. Lancet i, 605608.CrossRefGoogle Scholar
Kedward, H. (1969). The outcome of neurotic illness in the community. Social Psychiatry 4, 14.CrossRefGoogle Scholar
Locke, B. Z. & Gardner, E. (1969). Psychiatric disorders among the patients of general practitioners and internists. Public Health Reports 84, 167173.CrossRefGoogle Scholar
Mann, A. H., Jenkins, R. & Belsey, E. (1981). The twelve-month outcome of patients with neurotic illness in general practice. Psychological Medicine 11, 535550.CrossRefGoogle ScholarPubMed
Regier, D. A., Goldberg, I. D. & Taube, C. A. (1978). The de facto US mental health services system. Archives of General Psychiatry 35, 685693.CrossRefGoogle Scholar
Regier, D. A., Rosenfeld, A. H., Burns, B. J., Goldberg, I. D. & Hoeper, E. W. (1979). Nature and scope of mental health problems in primary care. In A Conference Report: Mental Health Services in General Health Care, vol. 1, pp. 4150. Institute of Medicine, National Academy of Sciences: Washington, D.C.Google Scholar
Regier, D. A., Goldberg, I. D., Burns, B. J., Hankin, J., Hoeper, E. W. & Nycz, G. R. (1982). Specialist/generalist division of responsibility for patients with mental disorders. Archives of General Psychiatry 39, 219224.CrossRefGoogle ScholarPubMed
Regier, D. A., Myers, J. K., Kramer, M., Robins, L. N., Blazer, D. G., Hough, R. L., Eaton, W. W. & Locke, B. Z. (1984). The NIMH epidemiologie catchment area (ECA) program: historical context, major objectives, and study population characteristics. Archives of General Psychiatry 41, 934941.CrossRefGoogle Scholar
Shepherd, M., Harwin, B. G., Depla, C. & Cairns, V. (1979). Social work and the primary care of mental disorder. Psychological Medicine 9, 661669.CrossRefGoogle ScholarPubMed
Shepherd, M., Cooper, B., Brown, A. C. & Kalton, G. W. (1980). Psychiatric Illness in General Practice (second edn). Oxford University Press: London.Google Scholar
Shildkraut, J. J. & Klein, D. F. (1975). The classification and treatment of depressive disorders. Manual of Psychiatric Therapeutics. Little, Brown & Co.: Boston.Google Scholar
Spiegel, J. S., Rubenstien, L. V., Scott, B. & Brook, R. H. (1983). Who is the primary physician? New England Journal of Medicine 308, 12081212.CrossRefGoogle ScholarPubMed
Spitzer, R. L., Endicott, J. & Robins, L. (1978). Research diagnostic criteria: rationale and reliability. Archives of General Psychiatry 35, 773782.CrossRefGoogle ScholarPubMed
Taylor, L. & Chave, S. (1964). Mental Health and Environment. Longmans, Green & Co.: London.Google Scholar
Tessler, R. C., Bernstein, A. G., Rosen, B. M. & Goldman, H. H. (1982). The chronically mentally ill in community support systems. Hospital and Community Psychiatry 33, 208211.Google Scholar
World Health Organization (1978). Primary Health Care. WHO: Geneva.Google Scholar
World Health Organization (1980). International Classification of Impairments, Disabilities, and Handicaps. WHO: Geneva.Google Scholar
World Health Organization (1981). Current State of Diagnosis and Classification in the Mental Health Field. WHO Publication No. MNH/81.11, WHO: Geneva.Google Scholar